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The Affordable Care Act just narrowly escaped another near-death experience in its first year of full-scale implementation.
Emergency repairs to a dysfunctional website and redistribution of tens of billions of dollars of Other People’s Money as insurance subsidies produced a “mitigated” disaster at best.
In squeezing perhaps as many as 7 million desperate individuals into its precarious health exchange coverage by any means necessary, the Obama administration haphazardly broke whatever managed to get in its way.
Obamacare caused the cancellation of more affordable insurance plans that no longer fit its made-in-Washington mandates. It reduced work hours and job opportunities in sluggish labor markets. It expanded a bloated and unreformed Medicaid program, while cutting back funding to pay for Medicare benefits and raising a host of hidden taxes. It kept cutting special deals with political cronies and turned last-minute bureaucratic improvisation around the rule of law into a bizarre art form.
This shameful performance provides little reason to take a victory lap. The clock is still ticking on larger health-care problems ahead. They have only been worsened by this initial, diluted dose of Obamacare.
The core of the Affordable Care Act was built on such a structurally unsound foundation that it needs far more than an incremental handful of short-term repairs to overcome its congenital defects.
Opponents in Congress cannot afford to concede defeat grudgingly, but they should not hold out endlessly for simplistic repeal of the health law and nothing else. Neither tinkering around the edges of the ACA disaster site nor imagining a return to an older status quo will work. We can, and must, do better.
A carefully developed but still far-reaching renovation project remains immediately ahead.
It has to start with a more open and transparent policy debate that trusts the personal decisions of average Americans and provides more patient-centered health care choices.
The ACA instead overloaded the circuits of our poorly performing political system. It added more unpaid welfare-state promises onto younger and future generations. Then it outsourced resolution of its many contradictions and complexities to the arbitrary judgments of unaccountable bureaucrats.
Replacing the health care law means relying on more competitive health care markets, decentralizing decision-making, enhancing information transparency and realigning incentives to reward responsible choices and ensure accountability.
The key features of a new law to address old problems and future challenges in this manner are clear.
Congress should replace the counterproductive coverage mandates for individuals and employers with smarter incentives to maintain continuous insurance protection. The scope and scale of health insurance should be shaped by the preferences and needs of empowered consumers instead of an ever-thickening set of government edicts that choke off meaningful choice and competition.
Taxpayer subsidies need to be retargeted to assist the most vulnerable Americans without creating an ever-expanding web of political dependency further up the income ladder. We can afford to be compassionate and generous to Americans in distress but still respect the limits of our nation’s resources and the competing claims on them.
However, we cannot keep adding new entitlement program commitments to overburdened taxpayers while failing to fund and manage adequately our existing ones. Medicare reforms are needed to stabilize the future solvency and security of the past promises made to seniors, rather than to serve as a piggy bank for Obamacare’s expansion. Medicaid should return to its core mission of assisting the most medically needy low-income Americans, instead of stretching its coverage even wider and thinner by paying medical providers so little.
Health care reforms should encourage and reinforce broader macroeconomic policies that help revive and sustain economic growth. Improving the overall ratio between independently productive citizens and those who must depend on them offers the best insurance policy of all. Expect voters to send that message to their past and future representatives in Washington this November.
Tom Miller is a resident fellow at the American Enterprise Institute and author of “When Obamacare Fails: The Playbook for Market-Based Reform.”
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